[Minimally invasive surgical treatment for mid-esophageal and epiphrenic diverticula]

We report thoracoscopically or laparoscopically successfully treated patients with giant mid-esophageal and epiphrenic diverticula. Four patients presented with significant dysphagia for solid food, retrosternal pain, regurgitation and weight loss. They underwent the following gastroenterologic investigations: barium swallow, esophagoscopy, bronchoscopy and esophageal pH- and manometry. In two patients just below the trachea bifurcation, sacciform mid-esophageal diverticula of 10 to 12 cm without significant esophageal motor alteration were diagnosed. In the other two patients 8-10 cm large epiphrenic diverticula were diagnosed--one of them was associated with achalasia.

The midesophageal diverticula were resected via thoracoscopic access. The mobilized diverticula were resected with endo-GIAs. Trans-hiatal laparoscopic approach was applied for the dissection and resection of epiphrenic diverticulum. In one patient the resection was completed with esophago-cardiomyotomy and anterior partial fundoplication. During the operations continuous endoluminal endoscopic control was provided. There were no intraoperative complications. Oral feeding was started on the 6th postoperative day after control esophagography. The thoracoscopic or trans-hiatal laparoscopic resection of esophageal diverticula is safe, reduces postoperative morbidity and helps rapid return to normal activity.